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IUD Toolkit

Up-to-date evidence and best practices related to the Intrauterine Device

Brought to you by USAID's Maximizing Access & Quality Initiative

Infection Prevention Practices for IUD Insertion and Removal

Although the primary infection concern during insertion of IUDs is pelvic inflammatory disease (PID), the risk of PID attributable to the IUD is considerably lower than believed. The risk relates to progression of gonorrhea or Chlamydia infection present in the cervix at the time of insertion and not to the IUD itself. Infection Prevention (IP) procedures have little or no effect on the course of gonorrhea or Chlamydia infections; nonetheless good IP practice is important in helping protect both clients and providers from infection in general.

Minimizing the risk of infection at the time of IUD insertion requires compliance with these simple but practical infection prevention practices:

Routine handwashing before and after a procedure. Vigorously wash hands using soap and clean, running water for 15 seconds and then air dry or use a personal towel. Alternately, an alcohol-glycerin solution is an acceptable step for a water-free hygiene technique.
Wearing gloves during procedures as well as while handling waste and cleaning. The following chard explains which kinds of gloves are appropriate for most tasks. Gloves generally do not need to be sterilized.

TASK or ACTIVITY	ARE GLOVES NEEDED?	PREFERRED GLOVES*
Pelvic examination	Yes	Exam
IUD insertion (loaded in sterile package and inserted using no-touch technique)	Yes	Exam
IUD removal (using no-touch technique)	Yes	Exam
Handling and cleaning instruments	Yes	Utility
Handling contaminated waste	Yes	Utility
Cleaning spills of blood or other body fluids	Yes	Utility

* Examination gloves are disposable, clean gloves usually made of latex. Surgical gloves are disposable, sterilized gloves in surgical procedures. While disposable, they are sometimes reprocessed for re-use. Utility gloves are thick rubber gloves that are commonly used for household cleaning. As an alternative to exam gloves, surgical gloves may be used. As an alternative to utility gloves, either exam or surgical gloves may be used.

Using high-level disinfected (or sterile) instruments. Before use, "high level disinfect" (HLD) or sterilize instruments such as the speculum, tenaculum, uterine sound, and scissors for insertion and removal.
Loading the IUD within the sterile package using the "no-touch loading" technique. This simple but extremely important step helps prevent the IUD from being contaminated before it is inserted.
Cleaning the cervix with antiseptic for both IUD insertion and removal. Although the mucosa cannot be sterilized, antiseptic preparation of the cervix and vagina minimizes the number of microorganisms on the client's cervix. After the speculum is inserted, thoroughly apply antiseptic solutions such as povidone iodine two or more times to the cervix (especially the os) beginning at the center of the os and moving outward on the cervix and into the surrounding vaginal canal.
Inserting the IUD using the "no-touch insertion technique" to reduce contamination of the uterine cavity. Do not let the uterine sound or loaded IUD touch the speculum or vaginal canal or pass the uterine sound or loaded IUD through the cervical os more than once. This step minimizes the introduction of a load of microorganism into the uterine cavity.
Decontaminating instruments after the procedure. This is the first step in handling contaminated instruments and other items. Immediately after use, place instruments and other items in a 0.5% chlorine solution for 10 minutes. This step rapidly inactivates HBV and HIV and makes items safer to handle by personnel who clean them. When decontaminating gloves, briefly immerse gloved hands in a container filled with 0.5% chlorine solution (or other locally available disinfectant). Then remove gloves and soak them in the chlorine solution for 10 minutes.
Proper processing and storage of gloves and instruments. The three basic steps for processing instruments, gloves, and other items used for IUD insertion and removal are decontamination, cleaning, and HLD or sterilization. When sterilization equipment is not available, HLD is the only acceptable alternative. High-level disinfection can be achieved by boiling items in water, steaming them, or soaking them in chemical disinfectants such as 0.1% chlorine, or 2% glutaraldehyde. Because boiling and steaming require only inexpensive equipment, that usually is readily available, they are the preferred methods for small clinics or those located in low-resource settings. Regardless of the method selected, however, HLD is effective only when instruments and other items first are decontaminated and then thoroughly cleaned and rinsed before HLD.
Appropriate disposal of contaminated waste. After completing either an IUD insertion or removal, and while still wearing gloves, dispose of contaminated objects (IUD inserter tube and rod, cut end of the IUD thread, gauze, cotton, and other waste items) in a properly marked, leak-proof container with a tight-fitting lid or in a plastic bag.

It is not necessary to have sterile instruments or gloves. High-level disinfection for instrument by boiling, steaming, or use of chemical disinfectants, and clean exam gloves are sufficient to provide IUD services with low risk of infection for both clients and service providers.